I recently listened in to a Webinar related to infectious disease prevention strategies in elementary schools. The lead speaker (Dr. Thomas Sandora) was the principal investigator of a research study that was sponsored by Clorox and published in the Journal, Pediatrics a few months ago. I thought the results were interesting.

Study Design

This study was a randomized, controlled trial of 285 third to fifth graders in a school in Avon, Ohio. The study took place over a two-month period: from March to May, 2006. Half of the classrooms were randomized to the intervention group (which included having the kids apply hand sanitizer before and after lunch, and the teachers perform a sanitary wipe down of all their desks once/day), the other half were observed during their “business as usual” daily routine without sanitizers. The primary outcome measure was “days of school missed due to illness – either upper respiratory or gastrointestinal.” Swabs of surfaces in both the intervention and control groups were taken.

Results

Interestingly, there was no difference in the groups in terms of days of school missed due to upper respiratory type illnesses. There was a small but significant (9%) reduction in gastrointestinal-related illnesses absenteeism in the intervention group. Surface swabs picked up norovirus with higher frequency in the control group classrooms. No MRSA was detected during the study.

Discussion

Upper respiratory tract infections (URIs) are highly contagious, and are commonly spread by droplets in the air as well as surface contact (some viruses and bacteria can survive for 2 hours or more outside the body). Due to an infected child’s continuous contact with their own nasal secretions (sorry for the graphic photo), it is difficult to reduce the spread of URIs through the occasional hand washing or sanitizing. One would have to wash a child’s hands after each time they touched their mouth or nose.

On the other hand, gastrointestinal infections like norovirus are spread via the fecal-oral route, and are therefore not dripped and sneezed all over the place the way URI-causing viruses tend to be. Instead, GI infections are spread when hands are not washed thoroughly after a trip to the bathroom – and then food is touched and ingested.

So it’s not all that surprising that the transmission of GI-related infections were particularly susceptible to this study’s intervention: hand sanitizing before and after lunch, and a daily desk surface wipe.

An interesting point that Dr. Sandora made was that alcohol-based hand sanitizers don’t contribute to antibiotic resistance, because their killing mechanism is not related to antibiotics. I guess it’s like saying that humans don’t become resistant to knife injuries when exposed to attacks with greater frequency.

Conclusions

Hand sanitizer and surface disinfectant strategies may be more effective in reducing the transmission of gastrointestinal illnesses than respiratory tract illnesses in elementary school children. But since compliance is challenging – the total reduction in GI illness transmission remains modest though probably worth the hygiene effort. One glance at the photo above tells you all you need to know.

Most people assume that the flu is an inconvenience – an infection that causes a week of fevers, body aches, and discomfort. But it can be far more serious than that. In some cases, the virus can be fatal. I interviewed Joe Lastinger about the tragic loss of his 3 and-a-half year-old daughter to influenza. You can listen to our interview here.

Dr. Val: I’m so sorry to hear about your daughter’s death from influenza. Can you tell me a little bit about the events that led up to it?

Joe: The events were pretty unremarkable, until she died suddenly. Emily was three and a half at the time and had just started pre-school. One day she came home from school and she was very tired. She wanted to take a nap. Normally she didn’t take naps so we knew something was different. We took her to the pediatrician the next day and she was diagnosed with the flu. We were counseled to give her fluids, Tylenol and Motrin around the clock to control her fever, and to expect it to resolve in about a week.

However, Emily began experiencing more nausea a few days in. We contacted the pediatrician and she asked us a series of questions about her symptoms – but since she was urinating regularly, wasn’t having bloody vomit, or any other serious symptoms we were reassured. The next day my wife was in the kitchen (near the bedroom where she had left Emily) and I heard her scream. She found Emily on the ground, not breathing. We called 911 and the paramedics were able to get her heart started. She was transferred to the local children’s hospital, and was intubated. Unfortunately there was never any sign of brain activity and they slowly maxed out all the drugs they were giving her to keep her alive.

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